Individual
DR. CARLOS ERNESTO NOLASCO MORALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2317 S BATES AVE, SPRINGFIELD, IL 62704-4337
(866) 477-7472
(217) 717-2268
Mailing address
2317 S BATES AVE, SPRINGFIELD, IL 62704-4337
(866) 477-7472
(217) 717-2268
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-138431
IL
207RH0005X
Hypertension Specialist Physician
036138431
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138431
—
IL
01
—
F400698494
MEDICARE PTAN
IL
Enumeration date
07/19/2012
Last updated
12/02/2020
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